When sex hurts: Helping couples cope with genital pain

Dr. Natalie Rosen, of the Department of Psychology and Neuroscience and the Department of Obstetrics and Gynaecology, is developing new supportive approaches for women and couples coping with genital pain. She has just received $125,000 in funding from the Canadian Foundation for Innovation (CFI) to help develop infrastructure for her Couples and Sexual Health (CaSH) Laboratory at Dalhousie.

Housed in the Life Sciences Centre, the CaSh lab will have space for researchers and graduate students, and important behavioural testing equipment. It will also have additional rooms for both clinical therapy and physiological testing of women with genital pain and their romantic partners.

The funding will help Dr. Rosen research the psychological and interpersonal factors that affect women suffering from genital and pelvic pain experienced primarily during intercourse — a condition that mystifies doctors and leaves many women and couples vulnerable to its negative impacts.

A secret suffering

While it is unsurprising that pain experienced by women during sex is left out of day-to-day conversations, the little-known fact that 16 per cent of women experience pain during intercourse makes you realize just how many women are suffering in silence.

The most common condition in premenopausal women is provoked vestibulodynia (PVD), chronic vulvo-vaginal pain that may not have any physical cues. Women with this condition often describe a burning sensation or feelings of being cut with a knife when pressure is applied to the vulva (i.e., during sex).

“Many women suffering from sexual pain will see several doctors before a correct diagnosis is made,” explains Dr. Rosen. “Because there can be no visible signs, many patients have been told the pain is in their head and this can be very invalidating and demoralizing to the women.”

Not only is the condition extremely painful, it can have a negative effect on a woman’s emotional health while also being a stressor on her intimate relationship.

“The pain is very real, and very serious,” explains Dr. Rosen. “It impacts woman both physically and emotionally and often impacts their closeness with their partner. Women typically report fears of losing or disappointing their partners because of the pain they experience during sex.”

Those experiencing such pain are often hesitant to seek treatment for PVD, especially since many women begin experiencing symptoms around the same time they become sexually active.

Envisioning stronger relationships

When it comes to women’s genital pain Dr. Rosen concentrates on the couple as a unit. Previous research on the subject had rarely included sexual partners, but she has found that helping partners learn how to effectively respond to women with PVD can not only reduce the negative emotional and interpersonal effects of the pain for women but also reduce the pain itself. Dr. Rosen was one of the first researchers to examine partner responses to women’s pain during sexual intercourse.

“How the partner responds to the woman when she is in pain or after intercourse can influence her pain directly as well as the sex lives of these couples,” says Dr. Natalie Rosen.

“We have found that negative responses such as expressing frustration or anger was related to an increase in a women’s pain and more sexual difficulties, but the same is also true when men are overly concerned,” explains Dr. Rosen. “When men are overly sympathetic it can make the women feel anxious and incapable of managing the pain, which may also lead her to avoid sex, and ultimately increase her pain and reduce sexual satisfaction.”

Dr. Rosen recommends that men take a more adaptive approach that acknowledges the pain, but discourages avoidance of all sexual activity. She says men could suggest other non-painful sexual activities that allow the couple to still feel close by creating a more positive environment for sexual intimacy that reduces anxiety and their pain.

Developing new treatments

Currently, she has two active studies in place examining the psychological and interpersonal factors affecting women suffering from genital and pelvic pain, funded by the Canadian Institutes of Health Research. The first is a daily diary study completed online for eight weeks in which women and couples self-report on their goals or reasons for having sex, as well as aspects of their relationship and sexuality, and women’s pain experiences. The aim is to better understand the links that exist between sexual motivation, the pain and its impact on sexuality and other interpersonal and psychological factors for the woman and the couple.

The second is a first of its kind. The Cognitive Behavioural Couple Therapy (CBCT) treatment program for women suffering from PVD, developed by Dr. Rosen and her team including a close collaborator at the University of Montreal (Dr. Sophie Bergeron), compares this new psychological treatment with a standard medical treatment of lidocaine, a local anesthetic.

“The goal is to learn whether one treatment is more effective than the other or whether both are effective,” explains Dr. Rosen. “We also want to learn whether the interventions differ in their ability to treat some of the negative aspects of PVD that women and partners often experience, such as reductions in sexual satisfaction and sexual function.”

So far in a pilot study, the team has found that couples have shown significant improvement after receiving cognitive behavioural couple therapy. The funding for the CaSH lab will help provide the infrastructure to continue this important research. Dr. Rosen’s work will benefit thousands of women and couples.

“I want to empower women and couples to better manage these pain conditions and reduce negative impacts on their relationships and sexuality,” says Dr. Rosen. “I believe my research is directly influencing the development of better treatment and better access to treatment for women and couples.”

In addition to the $125,000 from CFI, Dr. Rosen has applied for matching funds from the provincial government. She has secured additional in-kind contributions from vendors of her infrastructure as well as an Establishment Grant from the IWK Health Centre.

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If you are interested in participating in one of Dr. Rosen’s studies, you can contact the lab at PVDstudies@dal.ca, go to www.natalieorosen.com or call 904-494-4223

Students: If you are enrolled in at least one course at Dalhousie University, University of King’s College, or the Nova Scotia College of Art and Design, you are eligible to see the psychologist listed below, who specializes in sex and couple therapy, free of charge.